Antitrust Law Daily Wrap Up, ANTITRUST—D.D.C.: Medical school applicant states claim for unlawful horizontal restraint in the physician education market, (Sep 25, 2026)

By Justin Marcus Smith, J.D.

The complaint plausibly alleged that AAMC sets a uniform price for primary applications across member schools in a way that impedes competition leading to supracompetitive prices.

A medical school applicant stated a claim against the Association of American Medical Colleges (AAMC) for unlawful horizontal restraint of trade in the physician education market under Section 1 of the Sherman Act, held the federal district court in Washington, D.C. However, the applicant did not have standing in the market for medical school primary application platforms because she was an applicant, not a platform provider. The applicant therefore did not have a claim for unlawful restraint of trade in the market for medical school primary application platforms under Section 1, nor for monopolization in that market under Section 2. The applicant also failed to state a claim for unfair or deceptive trade practices under the D.C. Consumer Protection Procedures Act (CPPA) because the applicant did not meet CPPA definition of a consumer. Medical school applicants do not “normally” apply for medical school “for personal, household, or family purposes.” In light of these rulings, the court denied the AAMC Fed. R. Civ. P. 12(b)(6) motion to dismiss in part and granted it in part (Durbal v. Association Of American Medical Colleges, No. 1:25-cv-02537-AHA (D.D.C. Sep. 24, 2026)).

Background. A medical school applicant (applicant) sued the Association of American Medical Colleges (AAMC) for allegedly violating antitrust and consumer protection laws in its pricing of medical school applications. AAMC is a non-profit whose members include all accredited medical schools in the U.S.

The complaint alleged that AAMC, at the direction of its member medical schools, developed a centralized application platform called the American Medical College Application Service (AMCAS). According to the complaint, more than 90% of U.S. medical schools require applicants to submit primary applications through AMCAS. Application fees are $175 for the first school application, $47 for each additional application. AAMC facially sets the fees and has increased them over time. Schools may charge applicants directly for a secondary, school-specific application.

The applicant paid AAMC $625 for eleven primary school applications. She now sued on behalf of a putative class who paid primary application fees asserting claims for unreasonable restraint of trade in violation of Section 1 of the Sherman Act; monopolization in violation of Section 2 of the Sherman Act; and unfair trade practices in violation of the CPPA. AAMC moved for a Fed. R. Civ. P. 12(b)(6) dismissal for failure to state a claim.

Standing. The court agreed with AAMC that the applicant did not have standing to assert anticompetitive behavior in one of the relevant markets, the market for medical school primary application platforms. The court reasoned that the applicant was not a participant in that market.

The applicant premised her Section 2 monopolization claim and one of her unlawful restraint of trade claims on the market for platforms like AMCAS to handle primary applications to U.S. medical schools. A small minority of U.S. medical schools use platforms other than AMCAS. The applicant did not plausibly allege participation in this market. She was neither a competitor developing application platforms nor a medical school consumer of them. She was a participant in the market for physician education, not a participant in the market for the platform itself.

Even if the applicant plausibly alleged anticompetitive application platform conduct leading to anticompetitive effects in the physician education market, she would not have antitrust standing in the primary application platform market.

Horizontal restraint. Even accepting that the complaint described AAMC as a joint venture between its medical schools, the applicant plausibly alleged anticompetitive effects that would make AAMC price setting unlawful under the rule of reason.

At the motion to dismiss stage, the applicant only needed to allege a plausible actual or potential anticompetitive effect. Drawing reasonable inferences in the applicant’s favor, the complaint plausibly alleged that AAMC sets a uniform price for primary applications across member schools in a way that impedes competition. The applicant alleged the uniform pricing led to prices higher than they would be in a competitive market. The applicant supported this by reference to comparable application platforms in other higher education settings that operate in competitive markets. For example, the complaint alleged the “Common Application” for undergraduate schools allows individual schools to set their fee. Some charge no fee at all. The complaint also alleged a range of application prices for graduate business schools. In all, the court determined that the applicant plausibly alleged the AAMC prices for the AMCAS primary application are higher than what would be expected but-for the challenged restraints.

The applicant also alleged the primary application fees far exceeded costs of just a few dollars per application. The complaint suggested a massive markup relative to application processing costs in a competitive market. Again, the applicant described other higher education application processing services that charge less. On the whole, and taken as true, the allegations supported a reasonable inference that the alleged AAMC uniform pricing of medical school primary application fees led to anticompetitive effects.

AAMC argued the applicant did not allege a plausible unlawful restraint of trade because her complaint did not deal with possible procompetitive benefits of the alleged price setting, but the court noted the applicant did not need to rebut that argument at this stage. The court therefore concluded the applicant plausibly alleged that AAMC uniform pricing of application fees is an unreasonable restraint of trade in the physician education market under the rule of reason, in violation of Section 1 of the Sherman Act.

CCPA claim. The court found the applicant did not state a plausible CPPA claim. A valid claim for relief under the CPPA must originate in a consumer transaction, but the applicant did not plausibly allege that she and other applicants “normally” buy medical school primary application services “for personal, household, or family purposes” under the CPPA. Medical school applicants buy medical school primary application services to pursue professional interests and advancement. The court acknowledged that the decision to apply to medical school can, in a sense, be “personal,” but it did not follow that applicants “normally” apply for personal reasons.

The court rejected the applicant’s next argument, citing D.C. Court of Appeals case law, that buyers not engaged in the regular business of buying and then reselling will usually fall within the CCPA. The court reasoned that the decision to buy primary application services still reflected a professional purpose, the promotion of business or professional interests, not one for “personal, household, or family purposes.” Accordingly, the applicant did not state a CCPA claim.

The Case is No. 1:25-cv-02537-AHA.

Judge: Ali, A.

Attorneys: Bennett Rawicki (Hilgers PLLC) for Nirvana Durbal. Douglas Litvack (Jenner & Block LLP) for Assoc. of American Medical Colleges.

Companies: Assoc. of American Medical Colleges

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